Poster 1300 A Quarter Costing More Than 25 Cents: A Case of Recurrent Bowel Obstruction Caused by a Coin
Author Insight from George Khoudari, Unity Health System
What’s new here and important for clinicians?
The patient has Crohn’s disease with recurrent small bowel obstructions; this is a common scenario for Crohn’s patients, as the disease process causes scarring and narrowing of the bowel, which can lead to obstruction. Our patient accidentally swallowed a coin and forgot about it. He had multiple emergency visits, courses of steroids, and was under consideration for expensive biologic treatment for what seemed to be recurrent Crohn’s flare ups while the true problem was a quarter causing a partial obstruction. He could have required surgery if the quarter was not found and removed. The lesson to learn is that foreign body should be considered in the differential diagnosis of bowel obstruction, first or recurrent, even in adult patients with other pathology. Finding and pulling out the quarter by ileoscopy saved the insurance company, patient, and tax payers about $25,000 and avoided the risks of surgery and potentially toxic medications.
What do patients need to know?
Patients with Crohn’s disease should be extra careful to avoid things which may cause obstruction other than disease itself. While this patient did not remember the quarter, patients should be encouraged to share potentially relevant history with their physician.
Author Contact George Khoudari, Unity Health System
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